Leader of The Link: Nurse manager prepares to guide first-of-its-kind center

Today, when people are in crisis – especially involving drugs and alcohol – it typically leads one of two places.

To the hospital or to law enforcement.

But in a matter of weeks, those individuals and their loved ones will have another option.

The Link, a community triage center, is set to open in June at 132 N. Dakota Ave.

It’s put together by multiple partners: the city of Sioux Falls, Minnehaha County, Avera Health and Sanford Health, with the goal of offering an innovative approach to address gaps in critical services for people living with mental health and substance abuse challenges.

And it’s up to Madeline Miller to help bring that vision into reality.

Miller, who will serve as the nurse manager for The Link, began her career eight years ago as a registered nurse with Avera Behavioral Health, working in pediatric psychiatry. She’s certified in psychiatry and mental health nursing. After a few years, she moved into clinical informatics, which is an area where clinical health care teams mesh with information technology to create processes within the electronic medical record system.

“When I saw the nurse manager position at The Link open up, I applied as it seemed like a great chance to not only help start an important project from its beginnings, but to offer a service to the community that is truly needed,” she said.

“The Link will serve the community as a site that can help relieve pressure on our law enforcement, behavioral health and emergency services around Sioux Falls,” she continued. “We have high expectations and realize those who come to use these services will as well.”

We sat down with Miller to learn more about her and the unique place she will help lead.

What all does your new role involve?

We have a robust team and a number of key priorities, and in addition to serving as a nurse manager, I will also have an active role with our patients or clients. This idea began more than a decade ago, when stakeholders evaluated the need for a triage center for behavioral health and substance abuse. This group did its research and realized the need for a midlevel of care for people who might face these challenges.

Four partners – the city of Sioux Falls, Minnehaha County, Avera and Sanford – came together to create the governing board for The Link. Augustana University and University of South Dakota teams collected data, and the planning involved site visits to centers like this across the country.

So let’s be honest: Some people might just be tuning into The Link or really not know much about it. How would you explain what this is for them?

There are three main aspects of our initial offerings, and all are focused on a population that is 18 and older. The first is a short-term sobering observation program, giving people who need it a safe place to recover and to become less intoxicated. Right now, individuals in this condition often end up under the care of law enforcement, local ambulance services or the emergency department. Most times, none of those options are really the best place for those individuals to be. Our short-term sobering observation program will offer patients a chance to connect to available resources, as well as a space where they can regain their functional care for self. We hope we can help with additional support and programs to address their substance use, abuse or addiction.

In addition, we’ll offer case management agencies, working with Southeastern Behavioral Health and county officials, so we provide services to those who qualify or seek them out.

Our second primary effort will focus on withdrawal management, where we can add a higher level of medical management for individuals who face substance withdrawal. We can give them closer monitoring and help them with evaluations. We’ll have a chemical dependency counselor who will work with them to develop treatment plans tailored to their individual needs as they start their recovery journey.

The last aspect that our team at The Link will address is mental health crisis stabilization. We will offer 23-hour acute short-term stays for individuals who need that care. In some cases, this could be people who recently suffered trauma or have thoughts of self-harm. In that short stay with us, we can help chart their next steps, which might include inpatient care or other outpatient resources. This program is voluntary; we recommend individuals who might need involuntary mental health holds get them through a higher level of care.

In time, we hope to expand our offerings to include things such as medication management, especially for people who recently left an incarceration center, as well as opioid replacement therapy for people who face opioid-use disorders.

We know we’ll be busy, but we’re excited to address these challenges. We can really make a difference and help Sioux Falls emergency care providers and other services over a long-term approach.

Talk us through what happens when someone comes to The Link. What is the progression? And where do they go from there? Is there any follow-up with the clients?

The process will vary depending on the individual’s needs. In some cases, such as the sobering observation program, it might be a few hours on a single occasion. Most cases, we hope to serve as the starting point for change for those who realize they need it.

Since our team offers comprehensive care for a number of different situations, it will include follow-up care as well as referral to additional services in our health systems, our city and the county. Our operations are a part of the Avera McKennan Hospital & University Health Center system.

If I’m a family member or friend of someone who could use these services, what should I do?

We hope you will call us, and hopefully together we can convince your loved one to take part. But there has to be some willingness on their part. There are processes that can involve emergency commitments for drug and alcohol use in some cases, but we cannot provide involuntary mental health holds at our facility.

What kind of a need is this designed to fill in the community? Is this service really not available anywhere else?

The Link will be a unique center for a type of care that is available in other settings, but again, the need for services like we offer is substantial, not just in Sioux Falls, but across the nation. As a triage site, we see our role as helping to evaluate people in need and, as best we can, put them in touch with programs that can help them after our role with them is complete.

Right now, when people find themselves in any of these situations, law enforcement is most likely to interact with them, or they go to an emergency room. When we’re open, there will be a 24/7 therapeutic center that can help them instead.

How’s the construction coming along?

Everything is on track; we expect to open in June, and when we do, we know we’ll likely be quite busy because, as I mentioned, there is a great need for these services. We are doing all that we can to prepare, and we are so excited to get going. We have developed a great team of people – all of whom are very passionate – and we look forward to serving the population who needs us.

Who pays for these services and how?

While Avera is the operational partner who hosts these services, we receive our funding from the four-partner governing board, as well as from other community partners, contributors and financial donors. Any individuals or businesses who understand the importance of these services are encouraged to consider donations for our efforts too. We also want to thank the many organizations who already have made donations.

How are you staffing The Link? Do you need more people?

We’ll employ a dynamic team that includes my role as a nurse manager who also works with patients or clients. We’ll also have an advanced practice provider offering services weekdays, registered nurses who will be there 24/7, paramedics, behavioral health technicians, chemical dependency counselors and security. A number of peer support specialists will augment our team; they are addiction survivors who can help support our patients as they begin paths to recovery.

We are hiring for these positions, and that process is coming along well, but qualified people who are interested should visit our website, LinkSF.org. You can learn about careers available as well as ways you can contribute to the project by supporting our mission.

Will the public have a chance to come look at it?

Yes, we’ll host an open house for the public, and we hope many people will join us. It’ll be at The Link, 132 N. Dakota Ave. in Sioux Falls. It’s set for 2 to 3:30 p.m., Monday, May 17.

Talk us through the plan for opening. Is there a set opening day, will it scale up gradually?

We’ll open in June 2021, and we are still finalizing the plans for the first day. We have big goals – decreasing pressure on our jails, health care centers and emergency departments – and we’ll have all of our initial programs ready when we begin service.

We encourage everyone to visit LinkSF.org to learn more about the services we provide.